Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    effected before the development of the febrile stage, is commonly fol- lowed by immediate cessation of the vomiting. In the large majority of cases the disorder terminates in recovery or death prior to the period of foetal viability, so that the indication for the induction of abortion, and not of premature labor, must be considered. 13ut the same end may bo attained in almost every case by the judi- cious combination of the hygienic, medical, and gynecological methods of treatment which have just been mentioned. When the vomiting is not due to pregnancy, of course the interrup- tion of jiregnancy can have no directly favorable influence upon the course of the disorder. The rule that no ca.se of fatal vomiting in pregnancy can be regarded as due to pregnancy in the absence of an autopsy invalidates the statistics already mentioned, as well as those of Joiilin.' This observer has collected 121 cases of alleged pernicious vomiting of ]n’egnaucy, of which 49, or 44 per cent., were fatal. Observers of the largest general experience (C. Braun, Kiwisch, Hohl, Ahlfeld, Haiismann, Cohnstein, Cazeaux) have seldom or never been compelled to resort to this last expedient. Carl Braun* voices a very general professional conviction upon this subject in the following words: “I myself have never observed a lethal issue in consequence of the uncontrollable vomiting of preg- nancy. I lay the greatest weight upon the exjiectant management and more modern medicamentation, and am of the opinion that after a con- scientious estimate of all considerations and contraindications, artificial abortion may be omitted, notwithstanding its permissibility from a sci- entific point of view when extreme danger to maternal life has been determined by several physicians.” When serious disease of the decidua exists an important objection to the induction of abortion is removed. Plyalmn.—The excessive secretion of saliva in the absence of per- nicious vojuiting is a rare disorder of pregnancy. The symptom com- monly mak&s its appearance early and disappears spontaneously between the third and fourth months, although in exceptional cases it persists throughout the term of gestation, and even for some weeks after labor. The disorder is probably a reflex neurosis, and frequently returns in successive pregnancies. The comstant dribbling of the secretion from the buccal cavity is always annoying to the patient. When the quan- tity reaches several quarts per diem the patient’s life may be seriouslv endangered from inanition. Important qualitative changes occur in tlie saliva. The water is largely increased, while the organic and inorganic substances are diminished. In a case observed by Schramm® the disturbances of nutrition were probably due to the alteration in ' Collected from Deblet, Fabre, Gii4niot, and others. ’ Loc. cit., p. 842. ^ Berl. klin. Woehensekr., 1886, No. 49.